New thinking about flu vaccination

Prospects for increased influenza vaccine production are leading to more and different strategies to increase its uptake.

Posted May 28, 2007.

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Spring is in the air. For many physicians, it's the season of allergy complaints and questions about Lyme disease and West Nile virus. Contemplating the influenza vaccine is not a high priority.

But it is for physicians and those in public health who are trying to address the problems that have bedeviled flu vaccine distribution. Their new approaches -- and what is hoped will be standard operating procedure at the practice level -- were a central theme of this year's National Influenza Vaccine Summit, which was held last month and co-sponsored by the American Medical Association and the Centers for Disease Control and Prevention.

After all, although the flu bug is ever changing, it always holds the potential to do harm. On average, according to the CDC, every year an estimated 5% to 20% of the U.S. population gets the flu. More than 200,000 people are hospitalized because of complications, and about 36,000 die.

The good news is that flu vaccine makers expect 132 million doses -- a record-breaking haul -- to be available in the 2007-08 season. And with the number of manufacturers up from two to four and one more seeking Food and Drug Administration approval to enter the U.S. market, public health experts predict better supply stability.

These positive developments, though, have triggered a new set of challenges. The flu summit is the forum for finding and spreading the solutions.

The group, first convened by the AMA and CDC in 2001 to examine supply-related difficulties in the flu vaccine delivery system, has grown to include more than 225 experts representing more than 115 diverse organizations. Though these stakeholders continue to hold postmortems on recent bumpy seasons, they also are focused on developing ways to take advantage of the increased supply. The AMA, which encourages influenza vaccination and supports the equitable distribution of this commodity, continues to play a leadership role.

Much hope is pinned to the notion that the flu vaccine paradigm has changed. With production at full capacity, the vaccine will arrive in physicians' offices over the course of the entire flu season -- not just in October. As a result, flu shots should be given well into the new year. If this push is a success, then vaccine will not go to waste.

Physicians in the trenches have an essential role.

More than ever, physicians and other health care professionals should set positive examples by getting a flu shot. In addition, they should continue to advocate the importance of this annual protection to patients -- including parents of school-age children.

Because there should be more than enough vaccine to go around, the traditional vaccination window -- from October to Thanksgiving -- will not be the rule. Instead, physicians should keep in mind and convey to patients that late-season vaccinations are effective because influenza often does not peak until mid-February.

But the changing view on flu vaccine does not stop there.

On a systemic level, a better grasp is still needed regarding issues of supply and demand -- how many doses are discarded, by whom and how could they be redistributed effectively late in the season to those still in need. Gaining this insight will eliminate waste and relieve the financial burden experienced by physicians who pay for doses that go unused.

A new emphasis should be placed on improving communication between manufacturers, the government and vaccine providers to facilitate consistent and accurate vaccine availability. Outreach to the media and public education campaigns could reduce patient and physician frustration by helping all parties know more about vaccine availability, without creating a demand frenzy.

Lastly, attention must be paid to the various pending state legislative efforts that could complicate the already delicate vaccine delivery system and, if they are not drafted with care, could hinder equitable distribution of vaccine.

It might be only spring, but it is not too early to start changing the mind-sets that will determine whether this opportunity to protect the public health can be maximized.

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